Justice Committee on May 9th, 2016

[Chris Bittle, Liberal, St. Catharines, ON]

This is just an attempt to delay the process and cause undue delay.

Psychiatric services are so difficult to access. I had a client of mine who had a complete psychotic breakdown, and it took three days to get an emergency appointment on an emergency basis. I think this is one of those things where it's best to leave it to the colleges across the country...who is best to deal with these types of situations under their own rules of practice.

[The Chair, Liberal, Anthony Housefather]

Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

In order to activate this clause, it presupposes that the medical practitioner or physician who is contemplating performing the medical assistance in dying would recognize that. I think if they recognize that this person has a mental condition, as part of their own due diligence they would seek this kind of clarification as a matter of course. I think the amendment is redundant, and I will not support it.

[The Chair, Liberal, Anthony Housefather]

Mr. Warawa.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

I would suggest otherwise. We did hear from medical professionals who spoke to the committee, who said that physicians may not have that talent, that skill level, that expertise, to be able to determine whether or not the patient, the person requesting assistance in medical aid in dying.... That medical GP or nurse practitioner may not have that expertise, and in some cases will not have that. Yet, Bill C-14 will give them the authority to make that assessment without any expertise. We heard clearly from the CMA and other medical professionals on the importance of having a proper assessment.

We've also heard comments of the importance of being Carter-compliant. It was a competent, consenting adult. If somebody is not competent, who has an underlying medical or psychological or psychiatric condition, and you have somebody who is not an expert to determine whether or not they're competent, you'll end up putting at risk vulnerable Canadians.

I think the amendment is very appropriate. It's not redundant; it's necessary. For clarity of the legislation, it should be supported.

[The Chair, Liberal, Anthony Housefather]

Mr. Falk.

[Ted Falk, Conservative, Provencher, MB]

I think this is a unique amendment. It's not an amendment that's going to be applicable to every single case. There's a qualifier there: “if they suffer from an underlying mental health condition”. I think it's very important to note that, because if that is known, then there is every reason under the sun that a person should say, “Hold on here, let's just do a little check-in ourselves here, and let's get a second opinion from an expert in that field.”

If it's an individual who is just suffering from an intolerable and grievous medical condition, apart from a history of mental health, this wouldn't be applicable. This is applicable to a small number of cases of individuals who suffer from mental health, and it's just another check and balance to make sure we're getting it right, and that these people are actually competent to make the decision that they're making here.

[The Chair, Liberal, Anthony Housefather]

Mr. Fraser.

[Colin Fraser, Liberal, West Nova, NS]

While I understand the point of the amendment, we rely on health care providers to make this determination every day with regard to informed consent, with regard to accessing expert services, if required, in order to satisfy themselves that this decision is being made freely and voluntarily.

I believe what Mr. Bittle said earlier, that instituting safeguards that they feel are appropriate in order to address the issue is clearly something that should be left up to the medical profession and the provinces to deal with. I don't believe it's appropriate for the Criminal Code to be placing this onus on them when we rely already on health care professionals every day to make the determination about what is valid consent and not. I would note that we don't require any sort of similar scheme for other issues dealing with end of life, whether it be withdrawal services, for example. I believe this is adequately addressed by the medical profession. We should trust our doctors and nurse practitioners to make those decisions, which we rely on every day.

[The Chair, Liberal, Anthony Housefather]

Mr. Warawa.

[Mark Warawa, Conservative, Langley—Aldergrove, BC]

Chair, I'm thinking back to a meeting I had with a very well-known and well-respected retired internist. This former physician shared a number of stories where there had been a drop of continuum of care, where a person entered an emergency ward and somehow their chart was not being followed by the next doctor or the nurse. In the process somebody said that because of the pain, the patient was terminal. They were treated as a terminal patient, were over-prescribed a narcotic, and died.

In another example, the person had colitis, was in terrible pain, was not treated properly, and ended up with a perforated bowel. There was example after example. There are examples where physicians, because of the business or whatever...they are human beings and can make mistakes and not follow normal procedure.

If we're talking about an issue of competence, if you are not competent because you're bipolar and you're in a three-month low and you cannot buy a cellphone on a contract, but you cannot be assessed to see whether or not you qualify, the Carter decision says you must be competent to provide that. We're saying if it's a mental issue, you don't send somebody to a family doctor. A specialist has to determine whether or not you're competent. I think the amendment is reasonable considering we're talking about somebody with a mental or psychological issue. I support the amendment.

[The Chair, Liberal, Anthony Housefather]

Thank you very much.

I'm going to go to Mr. Cooper now to wind things up, unless somebody else has something to say.

[Michael Cooper, Conservative, St. Albert—Edmonton, AB]

Like other members of the committee, I trust medical professionals, but this legislation doesn't leave it to any one medical health professional to make a decision with respect to someone accessing physician-assisted dying. We say two medical professionals. Why? Because we want to mitigate risk. We don't simply say that someone can give an oral request to a physician, trusting that physician to understand the oral instruction. We say it has to be in writing.

In that regard, I believe this amendment is very much in line with other safeguards included in this legislation, that are good safeguards, and I believe this would enhance the legislation. It's not about delay. It's not about referring every patient. It is about ensuring. I believe that most physicians would refer a patient to a psychiatrist. I'm not questioning physicians. I think it does no harm and does a lot of good to be absolutely certain to the greatest extent that we can be that vulnerable persons do not fall through the cracks. I did not hear any evidence to indicate that any physician or any nurse practitioner is equipped to undertake that kind of analysis, so that's why I think this needs to be amended.

[The Chair, Liberal, Anthony Housefather]

Thank you very much.

(Amendment negatived [See Minutes of Proceedings])

We will move now to amendment CPC-13.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Mr. Chair, may I make an amendment to the text of this amendment?

[The Chair, Liberal, Anthony Housefather]

Yes, you may.

It's your motion, so you can move it however you want.

You wouldn't even need to amend, you'd move it differently.

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

I would like to strike the first phrase up to the comma.

[The Chair, Liberal, Anthony Housefather]

How would it read?

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

It would read, “they consulted a medical practitioner regarding palliative care options and were informed of the full range of options”.

[The Chair, Liberal, Anthony Housefather]

So you'd not have the words “in the 15 days prior to making the request”, the sentence would just start with “they”?

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Yes.

[The Chair, Liberal, Anthony Housefather]

And that's how you're going to move this?

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Yes, I think that's clear.

[The Chair, Liberal, Anthony Housefather]

Would you put that on a piece of paper and bring it to the clerk?

[Garnett Genuis, Conservative, Sherwood Park—Fort Saskatchewan, AB]

Okay.